Surgical system with workflow monitoring

ABSTRACT

A surgical system includes a sensor configured to detect a usage of a surgical object. The surgical system also includes a controller configured to assign a pre-defined order of planned steps of a surgical workflow, automatically distinguish between executed steps of the surgical workflow based on the usage of the object, based on distinguishing the executed steps of the surgical workflow, record a comparison of an actual order of executed steps of the surgical workflow with the pre-defined order of the planned steps, and generate feedback based on the comparison.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a divisional application of U.S. patentapplication Ser. No. 17/378,012, filed Jul. 16, 2021, which is acontinuation of U.S. patent application Ser. No. 16/522,303, filed Jul.25, 2019, which is a continuation of U.S. patent application Ser. No.13/728,800, filed Dec. 27, 2012, which claims the benefit of U.S.Provisional Application No. 61/582,159, filed Dec. 30, 2011, all ofwhich are hereby incorporated by reference herein in their entireties.

FIELD

The present invention relates generally to integrated configurations forconducting diagnostic and interventional procedures in an operatingroom, and more particularly to systems and methods for monitoring andimproving processes and subprocesses of such procedures.

BACKGROUND

Operating room space and time is are two of the most valuable and scareresources of many healthcare systems, and must constantly be optimizedto maximize the benefits for the insurers, hospitals, personnel, andpatients. With the added complexity of modern technologies utilized inthe typical operating room for diagnostic steps, such as imaging, andinterventional steps, such as bone cutting in an orthopaedic surgery,specialized pieces of hardware, and specialized teams with specializedtraining are required. Due to the number of variables presented in sucha scenario, there can be a fairly large variability in operating roomefficiency and effectiveness. For example, referring to FIG. 1A, atypical operating room configuration is illustrated showing a patient(2) on an operating table (26) with two additional personnel (4, 6) whomay be surgeons, assistants, nurses, or the like holding instruments ortools (12, 14 respectively) as they approach the patient to conduct adiagnostic or interventional step of the procedure. An instrument ortool rack or table (28) is shown holding additional instruments (8, 10,16), and in the depicted configuration, a robotic surgery system (12),such as that sold under the tradename RIO® by MAKO Surgical Corporationof Fort Lauderdale, Florida, features a robotic arm (22) that holds asurgical instrument (20) such as a bone removal burr or saw. Also shownis an optical tracking system (24), such as that sold under thetradename OptoTrak by Northern Digital, Inc. of Ontario, Canada, whichmay be utilized in association with markers attached to structures to betracked, such as one or more bones of the patient's body, certaininstruments or tools, and/or certain prostheses, reamers, or otherstructures. To conduct a diagnostic or interventional procedure withsuch an environment, a predetermined plan or protocol may be developedwith best patient results, surgical efficiency, and other factors inmind. For example, referring to FIG. 1B, a desired workflow foraccomplishing a given surgical intervention is depicted with sequentialprocedure steps (30, 32, 34, 36) happening at presumptively ideal ordesired time milestones (38, 40, 42, 44) during the procedure. Someprocedures, however, do not go exactly as planned, due, for example, tounexpected patient-related challenges, unpredicted instrumentationneeds, variability in the skill of the medical team, and the like. Insuch scenarios, the procedure can vary quite significantly from theplanned scenario and timing, and sometimes it is unclear to a particularteam what is the most efficient and efficacious way to continue movingforward toward completion of the case. There is a need to simplify andimprove the predictability and efficiency of operational workflows, suchas that described above in reference to FIG. 1B, to address variousfactors presented during diagnostic or interventional procedures in theoperating room environment. Configurations are presented herein toaddress this challenge.

SUMMARY

One embodiment is directed to a method for conducting a medicalprocedure in an operating room, comprising: using a first camera-based3-D motion sensor mounted in a known position and orientation relativeto a global coordinate system of the operating room to generate signalsrelated to the 3-D position of a procedure object in the operating roombased upon an outer shape of the procedure object relative to the firstcamera-based 3-D motion sensor; and automatically monitoring progress ofthe medical procedure with a controller based at least in part upon oneor more positions of the procedure object relative to time as comparedwith a predetermined operational plan for moving the procedure objectover time, the one or more positions based at least in part upon thesignals from the first camera-based 3-D motion sensor. The methodfurther may comprise determining the position and orientation of thefirst camera-based 3-D motion sensor relative to the global coordinatesystem of the operating room based upon signals generated from a secondsensor configured to generate the signals based upon repositioning orreorientation of the first camera-based 3-D motion sensor relative to anestablished registration position and orientation of the firstcamera-based 3-D motion sensor relative to the global coordinate systemof the operating room. The second sensor may comprise an accelerometer.The second sensor may comprise a joint motion encoder. The methodfurther may comprise operating the controller to adapt automatically toa change detected in the progress of the medical procedure by comparingthe monitored progress with a version of the predetermined operationalplan that is modified in accordance with the detected change. Theversion of the predetermined operational plan that is modified inaccordance with the detected change may be based at least in part upon apredetermined workflow logic schema. The predetermined workflow logicschema may be based at least in part upon previous surgical experience.The predetermined workflow logic schema may be based at least in partupon input from an expert. The expert may be located remote to theoperating room. The method further may comprise providing a videoconferencing interface to allow the expert to visualize and communicatewith persons located in the operating room. The method further maycomprise transmitting one or more images from the first camera-based 3-Dmotion sensor to the remote expert over the video conferencing interfaceusing a network connection. The method further may comprise providingone or more instrument identifying sensors coupled to one or moreinstruments within the operating room and operatively coupled to thecontroller, and identifying with the controller the one or moreinstruments based at least in part upon the one or more instrumentidentifying sensors. The one or more instrument identifying sensors maycomprise RFID tags. The method further may comprise providing one ormore personnel identifying sensors coupled to one or more personnelwithin the operating room and operatively coupled to the controller, andidentifying with the controller the one or more personnel based at leastin part upon the one or more personnel identifying sensors. The one ormore personnel identifying sensors may comprise RFID tags. The methodfurther may comprise providing one or more patient identifying sensorscoupled to a patient within the operating room and operatively coupledto the controller, and identifying with the controller the patient basedat least in part upon the one or more patient identifying sensors. Theone or more patient identifying sensors may comprise RFID tags. Themethod further may comprise providing an instrument tracker configuredto monitor a position of a procedure object in the operating room basedupon detection of reflected radiation from one or more markers coupledto the procedure object, the radiation emitted from the instrumenttracker. The one or more markers may comprise reflective spheres ordiscs. The procedure object may be selected from the group consistingof: a surgical instrument, an imaging system component, an instrumenttable, and an operating table. The procedure object may be a surgicalinstrument selected from the group consisting of: a manual surgical handtool, an electromechanical surgical hand tool, and a pneumatic surgicalhand tool. The procedure object may be an imaging system componentselected from the group consisting of: an X-ray source; an X-raydetector; and X-ray source-detector coupling member; an ultrasoundtransducer; a light source; a light detector; a magnetic field source;and a magnetic field detector. The method further may comprise providingan instrument table comprising a touch and object recognition surfaceoperatively coupled to the controller to facilitate identification ofobjects placed upon the surface. The method further may comprisevisually highlighting one or more objects that have been placed upon thesurface with the touch and object recognition surface.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a conventional operating room scenario with arobotic surgical system.

FIG. 1B illustrates a high level procedure plan and timing diagram.

FIGS. 2A-2C illustrate embodiments of integrated system configurationsin accordance with the present invention.

FIGS. 3A-3C illustrate embodiments of high-level integrated systemconfigurations in accordance with the present invention.

FIG. 4A illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 4B illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 4C illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 5A illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 5B illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 5C illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 6A illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 6B illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

FIG. 6C illustrates a technique for executing a procedure using anintegrated system in accordance with the present invention.

DETAILED DESCRIPTION

Referring to FIG. 2A, an embodiment is depicted wherein one or morecamera-based three-dimensional motion sensors (48, 50, 52) may beutilized to track in three dimensions the positions and/or orientationsof various hardware components within the fields of view (54, 56, 58) ofthese sensors. Suitable camera-based three-dimensional motion sensorsare available from Microsoft Corporation of Redmond, WA under thetradename Kinect®, or from OcuSpec, Inc., of San Francisco, CA, and arecapable of measuring three dimensional (i.e., including depth relativeto the perspective of the cameras in their coordinate systems 60, 62,64) with a relatively high degree of accuracy—and without fidicials orreflective markers, as is generally the case with other optical trackingtechnologies, such as the depicted and aforementioned optical tracker(24). With a plurality of camera-based three-dimensional motion sensors(48, 50, 52) oriented and placed to have converging fields of view (54,56, 58), as shown in FIG. 2A, many elements of the surgical environmentmay be tracked in real or near-real time, including the positions and/ororientations of tools (8, 10, 12, 14, 16) and other structures, such asa hospital bed (26), tool table (26), robotic surgery system (18),robotic arm (22), associated tool (20), or even aspects of the patient(2) or personnel (4, 6) anatomy. The camera-based three-dimensionalmotion sensors preferably are operatively coupled, such as by a leadwire (72, 74, 76) or wireless connection, to a controller (66), such asa computing workstation, which may be operatively coupled (70) to adisplay (68) and configured to monitor the positions, orientations,movements, and timing of various elements of the medical procedure athand, subject to an initial registration process by which the coordinatesystems (60, 62, 64) of the structures containing the tracking camerasof the one or more camera-based three-dimensional motion sensors (48,50, 52) are characterized relative to a global coordinate system (46) ofthe operating room (i.e. to provide for mathematical transformationbetween coordinate systems and therefore mathematically relationshipsbetween them). The camera-based three-dimensional motion sensors (48,50, 52) may be fixedly mounted to the ceiling or other structure of theoperating room, or may be movably mounted, in which case sensors such asaccelerometers, joint encoders may be utilized to maintain adeterminable geometric relationship between the sensorposition/orientation and the operating room global coordinate system(for example, in the case of an articulating arm with joints and jointencoders that couples a camera-based three-dimensional motion sensor tothe operating room). In the depicted embodiment wherein a roboticsurgery system (18) is included, such system is operatively coupled (78)to the controller, as is (80) the depicted optical tracking system (24).

Referring to FIG. 2B, an another embodiment, an identification sensor(86), in the depicted embodiment with a sensing zone (88) akin to acamera's field of view, may be added and operatively coupled (82) to thecontroller (66) to facilitate not only tracking of elements within thepertinent fields of view (54, 56, 58), but also identification of theparticular elements. In one embodiment, RFID technology may be utilized,with an RFID sensor (86) and RFID tags (84) coupled to variousstructures or “procedure objects” pertinent to the operational theater.For example, in the embodiment illustrated in FIG. 2B, RFID tags (84)are coupled to the instruments (8, 10, 12, 14, 16), the instrument table(28), the operating table (26), the patient (2), each of the otherpersonnel (4, 6), each of the camera-based three-dimensional motionsensors (48, 50, 52), the optical tracking system (24), the roboticsurgery system (18), and the associated robotic surgical systeminstrument (20). With such a configuration, the controller may not onlymonitor what various elements within the fields of view are doing interms of movement and/or reorientation, but also which elements arewhich in terms of affirmative identification.

Referring to FIG. 2C, a configuration similar to that of FIG. 2B isillustrated, with the exception that the operating table (28) of theembodiment of FIG. 2C features SmartSurface® technology, as availablefrom Microsoft and Samsung corporations, to provide a surface which notonly may be utilized to sense what items are touching it, but also theshapes of these items; further, the SmartSurface, preferably operativelycoupled (118) to the controller (66), may be utilized to signal theassociated personnel, for example, by placing an illumination highlightbelow the next tool that should be picked up in accordance with thepredetermined operational workflow. Further, the table (28) may featurea speaker or other sound emitting device that may be utilized to signalan operator that a SmartSurface (90) has something to add regarding theprocedure (i.e., the next tool to be picked up in accordance with thepredetermined workflow may be visually highlighted by the underlyingSmartSurface 90, and a beep or other sound may be utilized to get theattention of the personnel in the room so that they look over to thetable).

Referring to FIG. 3A, a master controller (96), such as a computerworkstation operatively coupled (100) to a database (98), may beutilized to provide a higher level of control and centralized processingand/or information flow connectivity (102, 104) to a plurality ofoperating rooms in a single hospital, or multiple locations. The mastercontroller and database may be located at the same location as one ormore of the intercoupled operating rooms, or may be located in a remotelocation and connected, for example, by the internet. For example,referring to FIG. 3B, in one embodiment, three hospitals with four totalconnected operating rooms (92, 94, 110, 112) may be operatively coupled(102, 104, 114, 116) via the internet or other networking configuration.Element 106 is utilized to illustrate a boundary between two locations(i.e., in the embodiment illustrated in FIG. 3B, the three hospitals andmaster controller (96)/database (98) are in different locations toillustrate that all of the assets need not be local to each other.

Referring to FIG. 3C, an embodiment similar to that of FIG. 3B isdepicted, with the exception that the embodiment of FIG. 3C features aninterconnected (120) expert interface subsystem (108), such as thoseavailable from the Tandberg/VideoConferencing division of Cisco Systemsof San Jose, CA under the tradename Cisco Telepresence®, which may beconfigured to allow an expert (i.e., such as a particular surgicalexpert, an expert on a particular diagnostic or interventional tool thatmay be of interest in the procedure in the interconnect operating room,etc.) or other person to transiently “join” a portion of an operatingroom procedure, for example, by using the display (68) intercoupled tothe controller (66) local to each of the operating room scenarios ofFIGS. 2A-2C.

Referring to FIG. 4A, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. With the patient prepared for the diagnostic and/orinterventional procedure (202), one or more camera-basedthree-dimensional motion sensors operatively coupled to a controller(204), and the coordinate systems of the camera-based three-dimensionalmotion sensor and operating room registered (206) so that the sensorsmay be utilized to accurately track positions and/or orientations ofvarious structures of interest relative to the operating room (andpatient, who presumably is resting relatively stably on an operatingtable which is in a locked position relative to the floor of theoperating room), the medical procedure may be conducted (210) while theoperatively coupled controller utilizes the various sensors to passivelyobserve events and keep track of pertinent information, such as theorder of events during the procedure, timing thereof, etc. Thisinformation may be utilized during or after (214) the procedure has beencompleted (212) to improve procedural efficiency, effectiveness,training, and other factors relative to the performance of the team andrelated systems for the patient care scenario.

Referring to FIG. 4B, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 4B differs from that of FIG. 4A inthat it includes the use of an identifier tag sensor (216), such as anRFID sensor, which may be utilized along with identifier tags, such asRFID tags, coupled to various structures or objects pertinent to theprocedure (218) to identify the objects while they are being trackedduring the procedure (220). This additional data may be utilized toassist with improving procedural efficiency, effectiveness, training,and other factors relative to the performance of the team and relatedsystems for the patient care scenario (222).

Referring to FIG. 4C, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 4C differs from that of FIG. 4B inthat it includes the use of a smartsurface, such as in an application ofa tool or instrument table surface (224). During the procedure, theintercoupled controller may observe the events of the procedure usingthe camera-based three-dimensional motion sensor, the identificationsensor, and the smartsurface device (226), and all of this data may beutilized to assist with improving procedural efficiency, effectiveness,training, and other factors relative to the performance of the team andrelated systems for the patient care scenario (228). For example, in oneillustrative scenario, the data may be utilized to determine that a newscrub nurse does not know the prescribed surgical workflow of a givenprocedure very well, and is fairly consistently reaching for the wrongtool from the smartsurface tool or instrument table. This data may beutilized to assist in training the new scrub nurse, or in changing theworkflow so that it is more intuitive or otherwise more efficient.

Referring to FIG. 5A, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 5A differs from that of FIG. 4A inthat it includes the active presentation of feedback (230) into theoperating room from the controller in an automated fashion during theprocedure. For example, in one embodiment, a display intercoupled to acontroller may be configured to consistently update a visualpresentation of what stage of the predetermined operational protocol,what stage is next, and if anything has been missed. In one embodiment,either a local controller or a master controller may aggregate data andintelligence regarding the particular procedure, and function akin to anIBM Watson type of artificial intelligence system. For example, in oneembodiment, the controller may follow along with the procedure, andgiven its understanding of the patient data, make a recommendation aboutstarting with a smaller tool, different angle, etc.

Referring to FIG. 5B, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 5B differs from that of FIG. 4B inthat it includes the active presentation of feedback (232) into theoperating room from the controller in an automated fashion during theprocedure. This embodiment, like that of FIG. 4B, features anidentification sensor, and thus enables a more sophisticated opportunityfor feedback from the controller. For example, in another variation ofthe aforementioned IBM Watson type of configuration, the system canidentify the physician doing the case and make recommendations to theother attending personnel regarding physician preferences (for example,it can “tell”, via the intercoupled monitor, via voice simulationthrough a speaker, etc., a scrub nurse that Dr Smith always likes tostart with a two-sizes down orthopaedic surgery broach, or that Dr Smithalways likes to have both A/P and lateral views of a targeted tissuestructure before proceeding with any cutting).

Referring to FIG. 5C, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 5C differs from that of FIG. 4C inthat it includes the active presentation of feedback (234) into theoperating room from the controller in an automated fashion during theprocedure. With an interconnected smartsurface, the feedback may bedispatched from the controller to the smartsurface as well as to thedisplay or other devices. In a further variation of the aforementionedIBM Watson type of configuration, the example described in reference toFIG. 5B may be expanded to additionally utilize the smartsurface toprovide feedback to personnel in the operating room—for example, bycommunicating the functional equivalent of, “Here—start with thisbroach, because Dr. Smith likes to start two sizes down” through themeans of highlighting or otherwise signaling which item to pick up usingthe interconnected smartsurface technology.

Referring to FIG. 6A, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 6A differs from that of FIG. 5A inthat it includes the active presentation of feedback (236) optionally inthe form of a live videoconferencing “patch” which may be presented onthe display which may be local to the operating room. Any kind ofexpert, or even nonexpert, assistance may be functionally brought intothe operating room which such a configuration, complements of integratedvideoconferencing technology.

Referring to FIG. 6B, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 6B differs from that of FIG. 5B inthat it includes the active presentation of feedback (238) optionally inthe form of a live videoconferencing “patch” which may be presented onthe display which may be local to the operating room. Any kind ofexpert, or even nonexpert, assistance may be functionally brought intothe operating room which such a configuration, complements of integratedvideoconferencing technology.

Referring to FIG. 6C, in one embodiment, a configuration such as thosedescribed above in reference to FIGS. 2A-3C may be utilized in a medicalprocedure. The embodiment of FIG. 6C differs from that of FIG. 5C inthat it includes the active presentation of feedback (240) optionally inthe form of a live videoconferencing “patch” which may be presented onthe display which may be local to the operating room. Any kind ofexpert, or even nonexpert, assistance may be functionally brought intothe operating room which such a configuration, complements of integratedvideoconferencing technology.

Various exemplary embodiments of the invention are described herein.Reference is made to these examples in a non-limiting sense. They areprovided to illustrate more broadly applicable aspects of the invention.Various changes may be made to the invention described and equivalentsmay be substituted without departing from the true spirit and scope ofthe invention. In addition, many modifications may be made to adapt aparticular situation, material, composition of matter, process, processact(s) or step(s) to the objective(s), spirit or scope of the presentinvention. Further, as will be appreciated by those with skill in theart that each of the individual variations described and illustratedherein has discrete components and features which may be readilyseparated from or combined with the features of any of the other severalembodiments without departing from the scope or spirit of the presentinventions. All such modifications are intended to be within the scopeof claims associated with this disclosure.

Any of the devices described for carrying out the subject diagnostic orinterventional procedures may be provided in packaged combination foruse in executing such interventions. These supply “kits” may furtherinclude instructions for use and be packaged in sterile trays orcontainers as commonly employed for such purposes.

The invention includes methods that may be performed using the subjectdevices. The methods may comprise the act of providing such a suitabledevice. Such provision may be performed by the end user. In other words,the “providing” act merely requires the end user obtain, access,approach, position, set-up, activate, power-up or otherwise act toprovide the requisite device in the subject method. Methods recitedherein may be carried out in any order of the recited events which islogically possible, as well as in the recited order of events.

Exemplary aspects of the invention, together with details regardingmaterial selection and manufacture have been set forth above. As forother details of the present invention, these may be appreciated inconnection with the above-referenced patents and publications as well asgenerally known or appreciated by those with skill in the art. The samemay hold true with respect to method-based aspects of the invention interms of additional acts as commonly or logically employed.

In addition, though the invention has been described in reference toseveral examples optionally incorporating various features, theinvention is not to be limited to that which is described or indicatedas contemplated with respect to each variation of the invention. Variouschanges may be made to the invention described and equivalents (whetherrecited herein or not included for the sake of some brevity) may besubstituted without departing from the true spirit and scope of theinvention. In addition, where a range of values is provided, it isunderstood that every intervening value, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range, is encompassed within the invention.

Also, it is contemplated that any optional feature of the inventivevariations described may be set forth and claimed independently, or incombination with any one or more of the features described herein.Reference to a singular item, includes the possibility that there areplural of the same items present. More specifically, as used herein andin claims associated hereto, the singular forms “a,” “an,” “said,” and“the” include plural referents unless the specifically stated otherwise.In other words, use of the articles allow for “at least one” of thesubject item in the description above as well as claims associated withthis disclosure. It is further noted that such claims may be drafted toexclude any optional element. As such, this statement is intended toserve as antecedent basis for use of such exclusive terminology as“solely,” “only” and the like in connection with the recitation of claimelements, or use of a “negative” limitation.

Without the use of such exclusive terminology, the term “comprising” inclaims associated with this disclosure shall allow for the inclusion ofany additional element—irrespective of whether a given number ofelements are enumerated in such claims, or the addition of a featurecould be regarded as transforming the nature of an element set forth insuch claims. Except as specifically defined herein, all technical andscientific terms used herein are to be given as broad a commonlyunderstood meaning as possible while maintaining claim validity.

The breadth of the present invention is not to be limited to theexamples provided and/or the subject specification, but rather only bythe scope of claim language associated with this disclosure.

What is claimed is:
 1. A surgical system, comprising: a sensorconfigured to detect a usage of a surgical object; and a controllerconfigured to: assign a pre-defined order of planned steps of a surgicalworkflow; automatically distinguish between executed steps of thesurgical workflow based on the usage of the surgical object; based ondistinguishing the executed steps of the surgical workflow, record acomparison of an actual order of the executed steps of the surgicalworkflow with the pre-defined order of the planned steps; and generatefeedback based on the comparison.
 2. The surgical system of claim 1,wherein the controller is configured to generate the feedback byidentifying a missed step of the planned steps and generating anindication of the missed step.
 3. The surgical system of claim 1,wherein the controller is configured to generate the feedback byautomatically generating a recommended change to the surgical workflow.4. The surgical system of claim 1, wherein the controller is configuredto generate the feedback by automatically generating a recommendedchange to a future surgical workflow.
 5. The surgical system of claim 1,wherein the controller is configured to generate the feedback byautomatically generating a recommendation to train a particular personinvolved in executing the surgical workflow.
 6. The surgical system ofclaim 1, wherein the sensor is a camera and wherein the controller isconfigured to identify motion of the camera.
 7. The surgical system ofclaim 6, further comprising an accelerometer coupled to the camera andconfigured to detect movement of the camera, wherein the controller isconfigured to identify the motion of the camera based on data from theaccelerometer.
 8. The surgical system of claim 1, wherein the sensor isa radio-frequency identification sensor, the surgical system furthercomprising a radio-frequency identification tag coupled to the surgicalobject.
 9. The surgical system of claim 1, wherein the sensor isconfigured to detect positions of the surgical object, and wherein thecontroller is configured to automatically distinguish between theexecuted steps of the surgical workflow by comparing the positions ofthe surgical object to planned positions for the surgical object. 10.The surgical system of claim 1, wherein the controller is configured asan artificial intelligence system.
 11. The surgical system of claim 1,wherein the sensor is configured to detect a position of the surgicalobject defined in a global coordinate system of an operating room. 12.The surgical system of claim 1, further comprising a robot operativelycoupled to the controller, wherein the surgical object is a portion ofthe robot or a tool held by the robot.
 13. A surgical system,comprising: a sensor positionable in an operating room and configured todetect a position of a surgical object in the operating room; and acontroller configured to: assign a pre-defined order of planned steps ofa surgical workflow; automatically distinguish between executed steps ofthe surgical workflow based on a change in the position of the surgicalobject; based on the distinguishing the executed steps of the surgicalworkflow, record a comparison of an actual order of the executed stepsof the surgical workflow with the pre-defined order of the plannedsteps; and generate feedback based on the comparison.
 14. The surgicalsystem of claim 13, wherein the controller is configured to generate thefeedback by automatically generating a recommended change to a futuresurgical workflow.
 15. The surgical system of claim 13, wherein thecontroller is configured to generate the feedback by adjusting aduration associated with the surgical workflow.
 16. The surgical systemof claim 13, wherein the controller is configured to generate thefeedback by determining and adopting an alternate version of thesurgical workflow.
 17. The surgical system of claim 13, wherein thecontroller is configured to generate the feedback by automaticallygenerating a recommendation to train a particular person involved inexecuting the surgical workflow.
 18. The surgical system of claim 13,wherein the sensor is a camera further comprising an accelerometercoupled to the camera and configured to detect movement of the camera,wherein the controller is configured to identify motion of the camerabased on data from the accelerometer.
 19. The surgical system of claim13, wherein the sensor is configured to detect the position of thesurgical object is defined in a global coordinate system of theoperating room.
 20. The surgical system of claim 13, further comprisinga robot operatively coupled to the controller, wherein the surgicalobject is a portion of the robot or a tool held by the robot.